Endocrine Abstracts

JOINT4015

Autoimmune diseases are rarely diagnosed during pregnancy due to physiological immunosuppression. Clinical hyperthyroidism affects only 0.1–0.4% of pregnancies, with Graves’ Disease (GD) responsible for 85% of cases. This report describes three cases of GD in healthy pregnant women with no prior thyroid dysfunction and one case of diabetic ketoacidosis (DKA) at delivery as the initial presentation of diabetes mellitus. 1. A 28-year-old woman, at 10 weeks of gestation: TSH <0.01mU/l(N 0.35–4.94), T4L 4.03ng/dl(N 0.7–1.48), T3L 16.8pg/ml(N 2.3–4.2), TSH receptor antibodies (TRAbs)11.0 (positive). Treatment was initiated with propylthiouracil (PTU) 50 mg 3id. At 15 weeks: TSH 0.03mU/l, T4L 0.50ng/dl, T3L 2.0pg/ml, leading to discontinuation of the antithyroid drug (ATD); at 29 weeks, TRAbs 2.6 (negative). At the first postpartum visit, she was euthyroid;14 weeks after delivery, GD recurred: TSH 0.01mU/l, T4L 2.51ng/dl, T3L 9.2pg/ml, TRAbs 5.4(positive). Methimazole 10 mg id was initiated. 2. A 32-year-old woman at 10 weeks of gestation: TSH 0.01mU/l, T4L 1.64ng/dl, T3L 4.9pg/ml, TRAbs 3.2(positive). PTU 50 mg id was started and discontinued at 20 weeks (TSH <0.01mU/l, T4L 0.79ng/dl, T3L 2.8pg/ml, TRAbs 2.9 (negative). She remained off therapy and, at six weeks postpartum, was euthyroid with TRAbs 2.4(negative). She is awaiting further evaluation. 3. A 34-year-old woman at 16 weeks of gestation: TSH <0.01mU/l, T4L 2.03ng/dl, T3L 7.8pg/ml, TRAbs 12.0(positive), initiating PTU 50 mg twice daily. At 19 weeks: TSH <0.01mU/l, T4L 0.84ng/dl, T3L 3.6pg/ml, leading to an adjustment to PTU 50 mg id. At 23 weeks, PTU was stopped due to TSH 0.02mU/l, T4L 0.86ng/dl, T3L 3.8pg/ml. She remained off ATD until delivery and is awaiting postpartum reassessment. 4. A 29-year-old woman, at 37 weeks of gestation was admitted to the Emergency Department with polydipsia, polyuria, weight loss, glycosuria (>1000 mg/dl) and hypertension. A cesarean section due to fetal distress was performed. Her fasting glucose in the first trimester was 81 mg/dl, and an oral glucose tolerance test(OGTT) at 26 weeks showed 84/149/119 mg/dl. During labor, sustained capillary glucose levels >500 mg/dl were observed, with pH 7.293, HCO3-9.5 mmol/l, lactate 2.3 mmol/l, ketonemia 4 mmol/l. Intravenous insulin infusion was initiated, with a favorable response. Good glycemic control was achieved after 19 hours. An intensive insulin therapy regimen was introduced. She was discharged after seven days of hospitalization. She is awaiting further evaluation and the results of autoantibody tests for T1DM. Despite the diagnosis of autoimmune disorders during pregnancy is rare, early detection and management of these conditions are essential to prevent maternal and fetal complications. Individualized follow-up is crucial for optimizing outcomes.